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目的探讨细胞外基质在早产儿慢性肺疾病(CLD)支气管肺泡灌洗液(BALF)中动态改变及其在CLD形成中的作用。方法对1999-12—2004-11在华中科技大学同济医院NICU住院需机械通气的62例患儿每日行支气管肺泡灌洗,并检测灌洗液中细胞总数及分类、透明质酸(HA)、Ⅲ型胶原(PCⅢ)及羟脯氨酸(Hyp)水平。病例分为4组:肺炎组20例;肺透明膜病(HMD)组13例;CLD组15例;对照组14例(无肺部疾病者)。结果(1)CLD组BALF中HA和PCⅢ水平分别较肺炎组及HMD组明显升高,并且也分别高于对照组BALF中的水平;(2)CLD组BALF中的HA和Hyp均分别与细胞总数和中性粒细胞数(%)呈正相关,而PCⅢ与肺泡巨噬细胞总数呈正相关。另外,HA、PCⅢ及Hyp之间均呈明显的正相关。结论CLD患儿肺内HA、PCⅢ及Hyp产生增多;BALF中HA、PCⅢ及Hyp的水平从不同侧面反映了疾病活动性并具有估计预后的作用。
Objective To investigate the dynamic changes of extracellular matrix in bronchoalveolar lavage fluid (BALF) of chronic obstructive pulmonary disease (CLD) in preterm infants and its role in the formation of CLD. Methods Sixty-two children admitted to NICU in Tongji Hospital of Huazhong University of Science and Technology during 1999.12-2004-11 were treated with bronchoalveolar lavage daily. The total number and classification of cells in the lavage fluid, hyaluronic acid (HA) , Type Ⅲ collagen (PC Ⅲ) and hydroxyproline (Hyp) levels. The patients were divided into 4 groups: 20 in pneumonia group, 13 in hyaline membrane disease (HMD) group, 15 in CLD group and 14 in control group (without pulmonary disease). Results (1) The levels of HA and PCⅢ in BALF in CLD group were significantly higher than those in pneumonia group and HMD group respectively, and were also higher than those in control group respectively. (2) The levels of HA and Hyp in BALF in CLD group were significantly higher than those in control group There was a positive correlation between the total number and the number of neutrophils (%), while PCⅢ was positively correlated with the total number of alveolar macrophages. In addition, there was a significant positive correlation between HA, PCⅢ and Hyp. Conclusions The levels of HA, PC Ⅲ and Hyp in lungs of children with CLD are increased. The levels of HA, PC Ⅲ and Hyp in BALF reflect the disease activity and prognosis in different aspects.